<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="{$row.user_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medical_username')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medical_username" class="form-control" name="row[medical_username]" type="text" value="{$row.medical_username|htmlentities}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medical_gender')}:</label>
        <div class="col-xs-12 col-sm-8">

            <div class="radio">
                {foreach name="genderList" item="vo"}
                <label for="row[medical_gender]-{$key}"><input id="row[medical_gender]-{$key}" name="row[medical_gender]" type="radio" value="{$key}" {in name="key" value="$row.medical_gender"}checked{/in} /> {$vo}</label>
                {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label for="c-medical_birth" class="control-label col-xs-12 col-sm-2">{:__('生日')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-medical_birth" data-rule="" class="form-control datetimepicker" data-date-format="YYYY-MM-DD" data-use-current="true" name="row[medical_birth]" type="text" value="{$row.medical_birth}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medical_cardno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medical_cardno" class="form-control" name="row[medical_cardno]" type="text" value="{$row.medical_cardno|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
